CASE STUDIES AND CLINICAL SITUATIONS

Chapter 5

1. A patient taken to the emergency room following an episode of syncope has a fasting blood glucose level of 450 mg/dL. Results of the routine urinalysis are as follows:

COLOR: Pale yellow KETONES: Negative

CLARITY: Clear BLOOD: Negative

SP. GRAVITY: 1.020 BILIRUBIN: Negative

PH: 5.0 UROBILINOGEN: Negative

PROTEIN: 1+ NITRITE: Negative

GLUCOSE: 250 mg/dL LEUKOCYTES: Negative

 

a. Explain the correlation between the patient’s blood and urine glucose results.

A) The renal threshold for glucose is exceeded.

B) The episode of syncope interfered with glucose reabsorption.

C) The specimen was not tested within 2 hours.

D) The renal threshold for glucose is lowered by syncope.

 

b. What is the most probable metabolic disorder associated with this patient?

A) Tubular necrosis

B) Neurological damage

C) Diabetes mellitus

D) Pancreatic insufficiency

 

c. Considering the patient’s condition, what is the significance of the patient’s protein

result?

A) No significance

B) Interference with the protein reaction by the acid pH

C. Possible onset of nephropathy

D) Proteinuria often occurs with syncope

d. What could have been done to delay the onset of proteinuria in this patient?

A) Nothing could be done as the syncope was sudden.

B) Regulate the patient’s blood glucose.

C) Ensure better hydration of the patient.

D) Keep the patient in a supine position.

e. If the patient in this study had a normal blood glucose level, to what would the urinary glucose be attributed?

A) Diabetes insipidus

B) Diabetes mellitus

C) High carbohydrate diet

D) Tubular necrosis

2. Results of a urinalysis performed on a patient scheduled for gallbladder surgery are as follows:

COLOR: Amber KETONES: Negative

CLARITY: Hazy BLOOD: Negative

SP. GRAVITY: 1.022 BILIRUBIN: Moderate

PH: 6.0 UROBILINOGEN: Normal

PROTEIN: Negative NITRITE: Negative

GLUCOSE: Negative LEUKOCYTES: Negative

a. What would be observed if this specimen were shaken?

A) A cloudy specimen

B) Yellow foam

C) White foam

D) No change

 

b. What confirmatory test can be performed on this specimen?

A) Ictotest

B) Clinitest

C) Acetest

D) Watson-Schwartz

 

c. Explain the correlation between the patient’s scheduled surgery and the normal

urobilinogen.

A) Possible bile duct obstruction

B) Pre-surgery transfusion

C) Patient is required to fast

D) Possible liver degeneration

 

d. If blood were drawn from this patient, how might the appearance of the serum be

described?

A) Milky

B) Clear

C) Red

D) Icteric

 

e. What special handling is needed for serum and urine specimens from this patient?

A) Refrigeration

B) Immediate testing

C) Protection from light

D) Transport in ice

 

 

3. Results of a urinalysis on a very anemic and jaundiced patient are as follows:

COLOR: Red KETONES: Negative

CLARITY: Clear BLOOD: Large

SP. GRAVITY: 1.020 BILIRUBIN: Negative

PH: 6.0 UROBILINOGEN: 12 EU

PROTEIN: Negative NITRITE: Negative

GLUCOSE: Negative LEUKOCYTES: Negative

a. Would these results be indicative of hematuria or hemoglobinuria?

A) Hematuria

B) Hemoglobinuria

b. Correlate the patient’s condition with the urobilinogen result.

A) Megaloblastic anemia

B) Iron deficiency anemia

C) Porphyria

D) Hemolytic anemia

c. Why is the urine bilirubin result negative in this jaundiced patient?

A) The bilirubin is conjugated.

B) The bilirubin is unconjugated.

C) The urobilinogen interferes with the bilirubin reaction.

D) Excess bilirubin is not being produced.

d. If interference by porphyrins was suspected in this specimen, how could this be

resolved?

A) Retest using Chemstrip

B) Perform Watson-Schwartz test

C) Perform Ictotest

D) Both A and B

4. A female patient arrives at the outpatient clinic with symptoms of lower back pain and urinary frequency with a burning sensation. She is a firm believer in the curative powers of vitamins. She has tripled her usual dosage of vitamins in an effort to alleviate her symptoms; however, the symptoms have persisted. She is given a sterile container and asked to collect a midstream clean catch urine specimen. Results of this routine urinalysis are as follows:

COLOR: Dark yellow KETONES: Negative

CLARITY: Hazy BLOOD: Negative

SP. GRAVITY: 1.012 BILIRUBIN: Negative

PH: 7.0 UROBILINOGEN: Normal

PROTEIN: Trace NITRITE: Negative

GLUCOSE: Negative LEUKOCYTES: 1+

Microscopic

8–12 RBC/HPF Heavy bacteria

40–50 WBC/HPF Moderate squamous epithelial cells

 

 

a. What discrepancies between the chemical and microscopic test results are present?

State and explain a possible reason for each discrepancy.

 

A) Color and specific gravity

B) Negative blood and microscopic

C) Negative nitrite and microscopic

D) All of the above

 

 

 

 

b. What additional chemical tests can be affected by the patient’s vitamin dosage?

A) Bilirubin and protein

B) Glucose and ketones

C) Bilirubin, LE, and glucose

D) Glucose, LE, and protein

c. Discuss the urine color and specific gravity results with regard to correlation, and give

A) The dark yellow color is caused by beta carotene.

B) The dark yellow color is caused by urobilinogen.

C) The specific gravity result correlates with a dark yellow urine.

D) The specific gravity is lowered by vitamin intake.

d. All of the following are reasons for a negative nitrite test in the presence of increased bacteria except:

A) Nitrite converted to nitrogen by heavy amount of bacteria

B) Presence of gram-negative bacteria

C) Hydration of the patient to produce urination quickly

D) Presence of gram-positive bacteria

5. Results of a urinalysis collected following practice from a 20-year-old college athlete are as follows:

COLOR: Dark yellow KETONES: Negative

CLARITY: Hazy BLOOD: 1+

SP. GRAVITY: 1.029 BILIRUBIN: Negative

PH: 6.5 UROBILINOGEN: 1 EU

PROTEIN: 2+ NITRITE: Negative

GLUCOSE: Negative LEUKOCYTES: Negative

The physician requests the athlete to collect another specimen in the morning prior to classes and practice.

 

 

a. What is the purpose of the second sample?

A) To analyze a fasting sample

B) To detect exercise-induced abnormalities

C) To confirm the negative glucose

D) To test for performance-enhancing drugs

b. What changes would you expect in the second sample?

A) Blood and protein

B) Protein and glucose

C) Bilirubin and urobilinogen

D) Blood and urobilinogen

 

c. Is the proteinuria present in the first sample of prerenal, renal, or postrenal origin?

A) Prerenal

B) Renal

C) Postrenal

6. A construction worker is pinned under collapsed scaffolding for several hours prior to being taken to the emergency room. His abdomen and upper legs are severely bruised, but no fractures are detected. A specimen for urinalysis obtained by catheterization has the following results:

COLOR: Red-brown KETONES: Negative

CLARITY: Clear BLOOD: 4+

SP. GRAVITY: 1.017 BILIRUBIN: Negative

PH: 6.5 UROBILINOGEN: 0.4 EU

PROTEIN: Trace NITRITE: Negative

GLUCOSE: Negative LEUKOCYTES: Negative

a. Is hematuria suspected in this specimen?

A) Yes

B) No

b. What is the most probable cause of the positive blood reaction?

A) Glomerular bleeding

B) Hemolytic anemia

C) Rhabdomyolysis

D) Exercise

c. What is the source of the substance causing the positive blood reaction?

A) RBC destruction

B) Glomerular damage

C) Kidney trauma

D) Muscle destruction

d. Would this patient be monitored for changes in renal function?

A) Yes

B) No

7. Considering the correct procedures for care, technique, and quality control for reagent strips, state a possible cause for each of the following scenarios.

a. The urinalysis supervisor notices that an unusually large number of reagent strips are becoming discolored before the expiration date has been reached.

A) They are stored in a plastic bottle.

B) The dessicant is left in the bottle.

C) The bottle is not being recapped.

D) The strips are not being used fast enough.

b. A physician’s office is consistently reporting positive nitrite test results with negative

LE test results.

A) The LE is read before the required reaction time.

B) The LE is being read after the required reaction time.

C) The nitrite is being read before the required reaction time.

D) Both the LE and the nitrite are being read before the required reaction time.

c. A student’s results for reagent strip blood and LE are consistently lower than those of

the laboratory staff.

A) The student is not running a control before the sample.

B) The student is reading the reactions after the recommended time.

C) The student is not mixing the sample prior to testing.

D) The student is not blotting the reagent strip.